Physician, heal thyself is a common refrain we have heard. In the mini docu-drama, Dopesick which many of us watched with great interest there is a telling dialog between Dr. Finnix and a state official. This was in either episode 5 or 6. Dr. Finnix gets addicted to prescription opioids and like many of his patients he starts on Suboxone and is doing well. He goes to the medical board seeking to get his medical license back and is told he cannot be on medication assisted treatment (MAT) to have his license reinstated. MAT for all practical purposes is either methadone or buprenorphine (Suboxone). These opioid meds are often described as the ‘gold standard’ of treatment. Wait a minute, Dr. Finnix cannot be on Suboxone, the ‘gold standard’ and practice medicine? Here in lies a paradox – physicians cannot practice what they preach when it comes to the treatment of addictive disorders!
Physicians are among the most trusted professionals to seek medical advice and referrals. “Ask your doctor” or “Let me check with my doctor” is the common response. What do physicians do when they find themselves addicted to drugs or alcohol? The immediate reaction is intense fear and anxiety, facing the specter of losing his/her license. They are aware about how expensive and disruptive treatment for physicians can be and may potentially jeopardize their careers. The physician my attempt to hide the problem in the hope of overcoming the problem. For many it is a downward spiral. The treatment programs for physicians are a lot more intense, expensive, and involve going to residential treatment followed by rigorous monitoring etc. No state medical board allows physicians to be on methadone and only a handful allow the use of buprenorphine if they want their medical license reinstated. The majority of physicians voluntarily agree to be on the non-opioid medication naltrexone, or the monthly injection of naltrexone called Vivitrol. The same is the case with airline pilots and interstate commercial truck drivers.
This begs the question, why the double standard? Do we have one standard to treat highly motivated patients and a different standard to treat ‘less motivated’. An interesting point to debate.
Percy Menzies, M. Pharm. is the president of Assisted Recovery Centers of America (ARCA), an integrated treatment center for addictive disorders and mental health based in St Louis. He can be reached at: firstname.lastname@example.org.